DESCRIPTION: This research project involves the development and empirical testing of a manual-driven cognitive-behavioral therapy for pediatric trichotillomania (TTM), a chronic impulse control disorder in which the individual acts on urges to pull out his/her own hair. Onset typically occurs by adolescence and TTM is often associated with significant functional impairment and distress, yet the scientific literature on TTM and its treatment is underdeveloped, especially with respect to pediatric TTM. Thus, the application is submitted in response to a request for applications for Exploratory/Developmental Grants for Psychosocial Treatment Research (R2 I). The major goals of the proposed study are to: (a) develop a cognitive-behavioral treatment for pediatric TTM that emphasizes relapse prevention techniques; (b) utilize expert opinion about TTM, manual development, CBT, and pediatric psychopathology to create a state-of-the-art treatment manual; (c) compare the efficacy of this manualized treatment to a control condition; (d) assess maintenance of gains following treatment discontinuation; and (e) use knowledge gained from this research endeavor as a springboard for future research into the efficacy and effectiveness of cognitive behavioral treatment for pediatric TTM. The investigators propose to conduct an initial pilot study in which four children age 8 to 12 and four adolescents age 13 to 17 will receive open CBT. These initial cases will be carefully evaluated using dependent measures such as independent evaluator ratings of TTM symptom severity and impairment, patient ratings of changes in hair pulling behavior and urges to pull across situations and body sites, clinician ratings of attainment of session goals and utility of specific clinical procedures, and consumer utilization and satisfaction ratings. Feedback from these various sources of information will be summarized and forwarded to the expert panel, which will then make additional suggestions for manual revisions. When the pilot study is concluded and manual revisions are complete, we will then conduct a randomized controlled trial. In this study, twenty-four patients age 8 to 17 inclusive who meet diagnostic criteria for primary TTM will be randomly assigned to CBT or a minimal attention control condition. The initial treatment phase will last 8 weeks; CBT responders will then enter an additional 8-week maintenance phase. Independent assessments of TIM severity and impairment will be conducted before, during, and immediately after the 8-week core treatment, during and following the 8-week maintenance phase, and at 3 about and 6-month follow-up. Long-range goals are to address the critical need for effective treatment for TTM in youth and to encourage dissemination of such treatments to practitioners, health care systems and families. Findings from the proposed research will provide initial empirical validation of the efficacy of a manualized CBT program for TIM, inform the field of this protocol-driven intervention, and promote future clinical research on this as yet neglected pediatric disorder.